Precaution while Chemotherapy - For attendant

I personally feel the real fight during chemotherapy cycle is from day5 to day 20(till the counts are recovered).

As a attendant we can take few precautions

1> Always wear face mask and if possible surgical cap too. ( Keep in mind a small sneeze can be life threatening for the patient as the counts are low.

Cost: Face Mask - Dispovan company mask usually cost you Rs175-Rs200 for 50pieces( 1 BOX)
and Johonson & Johonson face mask - Rs375 to 435 (20% discount on MRP minimum)
Separately Most of the medical shops sold Rs8/per mask hence prefer to go for a BOX


2> Try to wear fresh washed clothes and if possible keep separate cloths for inside and outside the room. We might have to go outside for medicines, water, food etc

3> Use separate room sleepers.

4> Do not allow any visitors specially Old. young kid and sick people to visit the patient. They can say hello from the gate. Remember a infection could be a end of fight.

5> Wash room every day, Use BASILOL spray ( ask for this spray from Senior Sister, it is not available in the market).

6> Keep Tiolet clean.

7> Most Importantly : Wash your hand with soap or Hand Sanitizer (Handrub from 3M company) every time you need to touch patient . In short keep yourself clean.


Sisters in OLD PRIVATE ward does not use mask regularly, do not hesitate to remind them to wear mask whenever they enter into the room

Important: HLA Test -- life saver

Assuming you are on day 10 and Induction Chemotherapy is completed.

This is the most critical phase of the treatment. Blood counts starts falling and need constant monitoring by the doctor,

What we(attendent) should do at this time?
1> Precaution for Attentdent:
Read my blog on Precautions for Attendent
But at this moment i am writing this post for taking future prospects, remeber this could be a life saver move. Please do not ignore or postpone HLA test.
2> Preparation for HLA Test for Bone Marrow Transplant(BMT)
- I will write about different types of BMT in future post.

HLA Test
Q: What is HLA?
A: HLA stands for human leukocyte antigen, a group of proteins present on the surface of all cells on the human body.

Each individual carries a particular combination of proteins in the HLA set. There are different types of HLA -- A, B, C, DP, DQ and DR. We all have 2 HLA molecules of each type, inherited from either parent. Therefore, the final HLA combination serves as a molecular identifier for an individual. The immune system of the body uses the HLA combination to identify each cell in the body as their own.

When ‘foreign cells’ in the form of organ or marrow transplants are placed inside an individual’s body, a mismatched HLA is recognized and the body may reject these cells or organs. The HLA sets of the donor and the recipient must be as close a match as possible for a successful transplant.

Identical twins have the same HLA set. Parents, siblings and even unrelated individuals may also have matching HLA. Lab tests can identify the HLA type of a person and test if another individual’s HLA matches it or not. HLA matching is an essential step before an allogeneic transplant

Q: Why should i think about Transplant at this point, i can be curable by chemotherapy?
Ans: I agree and probably most of the doctors in AIIMS might support you too. but please if the patient in younger than 60years and if you have the medical insurance or you are a government employee then there is no harm to go for this test at this time.
In case if doctors thinks about possiblities of Bone Marrow Transplant(BMT) then this you have to go through this process.
If patient is suffering from AML subtype M4, M5, M6 or M7 then this test is a must

Q: Ok,So how i should go about this Test? Does AIIMS have this facility? Any Private Lab?
Ans: Yes AIIMS have this facility, follow the following steps:
1> Your SR doc will fill a form and draw your family chart.
2> Take this form to Dept of Transplant Immunology and Immunogenetics just behind the director's office.
you will meet
Dr Uma Kanga
Senior Research Scientist
Dept of Transplant Immunology and Immunogenetics
All India Institute of Medical Sciences
Ansari Nagar, New Delhi-110029
Tel(O) 91 11 26594463, 26594638
Tel 9868397942 (mobile)
Fax 91 11 26588663
email : umakanga@hotmail.com

3> They will give you a date for the test - Probably it will be after 20days, Now for the patient, this test requires suffecient blood counts and no medicines in last 10days, after 20days we will be on day30th of chemotherapy, and the best time for this test. :-)

4> Who all going to be tested:
1> Patient
2> Patient Siblings : Best matching possiblities lies with them (25%)
3> Parents and Children: Depends upon your - chances are only (4%)
Note: In our case, we found the match with First Cousin (We have tested 15 people).
Please consult your family history with your doctor.
If you have any doubt please email me on shashank.chaturvedi@gmail.com

5> Price:
Each test will cost your Rs3,000 in AIIMS for intial Test and another Rs3,000 if you have a match.
In total keep around Rs20,000 for this test.


Want to be a donor? Read my blog: http://warwithbloodcancer.blogspot.com/2011/08/i-like-register-my-self-as-bone-marrow.html

Managing - Blood Donors and Platelet donors

Assuming you are on day 5 after hospitalization and Day 4 of Induction round of chemotherpay, by this time the blood counts are started falling,
RBC starts touching >3 and Hemogram stars droping to 8, platlet < 20K We need to arrange atleast 4 blood donor cards and 4 platelet donors, Only for First round of chemo, in total we need around 8-10 blood donors.
In All India Institute of Medical Science(AIIMS) we can get 3 units or RBC (blood)on a single donor card (we need to collect it back from the blood bank on the next day of transfusion - Timing: 11am-1pm and 2pm-4pm)

**IMPORTANT**
1> Keep in mind for SDP(single donor platelet) is a requirement based transfusion and your doctor probably give you 4-6hours to arrange a SDP, so keep your close relative or friends list with you who can come to AIIMS in short notice.

2> SDP is extracted in cell seperation room of C2 general ward, second floor.

3> Before SDP donation, donor need to be tested with Viral Marker and Hemogram test, This test need to be done on either a day before the donation or on the same day itself. This test can be done through external lab, Cell seperation incharge - Narender & Ominder ji can direct you to the LAB
Cost of the Test --- Rs1,000

4>SDP Kit: There are two kind of SDP Kit available, both are available only on Two shops near AIIMS
a) Impex India - Phone: 0-9910486274
b) Aark pharmaceuticals

Types of SDP Kit
a)Single Needle- This kit will take 1hour 10min to extract the SDP
Price: Rs6100-Rs6200
b) Double Needle - This will take 35minutes
Price: Rs 6,750 in Impex (last price update: 26th march 2011)

BEFORE TRANSFUION:
ALWAYS CHECK THE RBC IS OF YOUR BLOOD GROUP AND IRRADIATED

********Note*********
If a person donated Blood, he/she cannot donate blood or platelet for next 3 months,
but
A Person can redonate SDP (platelet) after 3 days and also can donate blood
So choose wisely who need to donate blood and platelet
*************************

Preparation with Mind and Medicines

Assuming by day 4 you get the room (blast in the peripheral blood > 50%)

We need to start preparing for the Chemotherapy, the general trend doctors in aiims follows, they gave to aroung 4-6 hours to get the medicines and prepare yourself for the chemo.

1> To get the medicines from the Market -- Keep in mind there is no medical shop inside the AIIMS campus, so you have to go to yusuf sarai market or gautam nagar or shops just outside the safdarjung hospital.

Also price of CYTOSAR 1gm (trade name of cytrabine)varies in every medicine shop. so choose wisely, i would recommend you to buy 6gm of cytosar for day 1 and then send some relative to survey the market.

36gm of cytosar and other induction chemo material usually cost you Rs40,000 - Rs 50,000.

Also mostly all the big medicines shops accept CREDIT CARD, but few small one can provide you medicines at cheaper rate if you have the cash in hand.

I will write a separate post on medicines shops around aiims, including there no. and rates of major medicines. if you need more info on the shops or cheapest price you can email me on shashank.chaturvedi@gmail.com


2> Peripheral intravenous line --- Usually by evening the on duty SR will come and starts the chemotherapy, the very first step is to implant a peripheral intravenous line in hand(assuming the patient is in normal health)
Question: Why this?
A: I would say this is the best thing to go with, you need to go through blood test on every Monday, Wednesday and Friday, plenty of antibiotics will go through your inter venous line, this line is painless and easy to manage.
Question: How to take care of this line?
Question: life of PIVC line?

Fight and Fight till the Lion(disease) becomes Lamb

Yes, that the word 'Fight',
We need to create a positive environment around the patient, we have to make sure he/she starts believing that they can fight with it, and can get through out of it.

By this time probably your fight is started now, (assuming you are day 2 )

TARGET 1: TO get a room.
you need to get a Private Room in the hospital or a Bed.

Usually AML cancer need to be treated aggressively { high dose of chemotherapy - 3gm per meter square = a 74KG man probably gets 36gm of CYTRABINE (CYTOSAR)}
This chemo kills all the blood cells includes cancer cells as well as healthy blood cells. Hence if it is possible try to go for a Private room.

In AIIMS private rooms are classified in two categories:
Class A -- room rent Rs1700/day + Rs 100 for meal
Class B -- room rent Rs1100/day + Rs 100 for meal

In total there are only 120 rooms (approx) including New Private Ward and Old Private Ward)

Keep in mind you are in the hospital for next 3months+
so choose your room wisely.

I will try to discuss Managing Money separately on a new post.